[New post] Watchdog report: Shaken-baby science doubts grow

medicalmisdiagnosisresearch posted: " Written by Steve Orr Staff writer-  http://www.democratandchronicle.com/ Eleven years ago, a Greece day-care provider was convicted of murder after the death of a 2½-year-old child who suffered a grievous head injury in the provider's home. Ren" Respond to this post by replying above this line New post on Medical Misdiagnosis Research Watchdog report: Shaken-baby science doubts grow by medicalmisdiagnosisresearch Written by Steve Orr Staff writer-  http://www.democratandchronicle.com/ Eleven years ago, a Greece day-care provider was convicted of murder after the death of a 2½-year-old child who suffered a grievous head injury in the provider's home. René Bailey, now 53 years old, remains in state prison.   Part II: Shaken-baby triad still rules in New York […] Read more of this post medicalmisdiagnosisresearch | July 5, 2013 at 2:49 pm | URL: http://wp.me/pIlqJ-15z Comment    See all comments Unsubscribe or change your email settings at Manage Subscriptions. Trouble clicking? Copy and paste this URL into your browser: http://medicalmisdiagnosisresearch.wordpress.com/2013/07/05/watchdog-report-shaken-baby-science-doubts-grow/ Thanks for flying with WordPress.com

[New post] Watchdog report: Shaken-baby triad still rules in New York courts

medicalmisdiagnosisresearch posted: " Written by Gary Craig Staff writer The case of Barbara Hershey — an Ontario County grandmother convicted of killing a 4-month-old boy — seemed to her appellate lawyers to be the perfect opportunity to attack the science of shaken-baby syndrome. " Respond to this post by replying above this line New post on Medical Misdiagnosis Research Watchdog report: Shaken-baby triad still rules in New York courts by medicalmisdiagnosisresearch Written by Gary Craig Staff writer The case of Barbara Hershey — an Ontario County grandmother convicted of killing a 4-month-old boy — seemed to her appellate lawyers to be the perfect opportunity to attack the science of shaken-baby syndrome. Shaken-baby syndrome — a diagnosis of brain trauma triggered by the vigorous shaking of a […] Read more of this post medicalmisdiagnosisresearch | July 5, 2013 at 2:14 pm | URL: http://wp.me/pIlqJ-15s Comment    See all comments Unsubscribe or change your email settings at Manage Subscriptions. Trouble clicking? Copy and paste this URL into your browser: http://medicalmisdiagnosisresearch.wordpress.com/2013/07/05/watchdog-report-shaken-baby-triad-still-rules-in-new-york-courts/ Thanks for flying with WordPress.com

[New post] http://fox8.com/2013/07/03/snapshot-device-helps-clear-father-in-babys-death/?hpt=ju_bn5

medicalmisdiagnosisresearch posted: "http://fox8.com/2013/07/03/snapshot-device-helps-clear-father-in-babys-death/?hpt=ju_bn5" Respond to this post by replying above this line New post on Medical Misdiagnosis Research http://fox8.com/2013/07/03/snapshot-device-helps-clear-father-in-babys-death/?hpt=ju_bn5 by medicalmisdiagnosisresearch http://fox8.com/2013/07/03/snapshot-device-helps-clear-father-in-babys-death/?hpt=ju_bn5 Read more of this post medicalmisdiagnosisresearch | July 5, 2013 at 8:43 am | URL: http://wp.me/pIlqJ-15n Comment    See all comments Unsubscribe or change your email settings at Manage Subscriptions. Trouble clicking? Copy and paste this URL into your browser: http://medicalmisdiagnosisresearch.wordpress.com/2013/07/05/httpfox8-com20130703snapshot-device-helps-clear-father-in-babys-deathhptju_bn5/ Thanks for flying with WordPress.com

Joss is home

Joss is home now! Of course, the case is not over. Nothing has changed, we as parent's haven't changed. We are still loving and want the best for our kids. The state stole our son for 17 of the first 18 1/2 months of his life, but now he's home. The transition period was a joke. He was ready to come home to us and has had NO trouble adjusting. Of course, he never should have been taken in the first place. Thank you friends for keeping up with us.

Vitamin D and Mushrooms

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Are you curious about how much vitamin D you're making as we approach summer? Here's a helpful hint!



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Salem News: State Sanctioned Kidnapping

Check out: Salem News: State Sanctioned Kidnapping

State Sanctioned Kidnapping

U.S. Observer

By Jim Dossett

Jim Dossett's Grandchildren

My understanding of the court system was similar to most Americans understanding of it. We read about court proceedings online, in newspapers and we hear about them on TV. Obey the law, no problem. Disobey the law and we have the finest system going. Our system compared to many is far and away the best. However it has, as I have come to learn, certain flaws that have evolved and have tilted the scales of justice.

My understanding of the court system in a nut shell was that, truth is found by careful and dutiful dissection in the court room. Evidence is paramount and lies are dissolved. Unfortunately politics, ego and dollars have consumed it.

This is our story. It could happen to anyone. It has and is happening here (Yamhill County Oregon) and around the country. Families are caught up in the bureaucratic functions of state departments so consumed by their internal policies that any attempt to cast reason their way is met with condemnation. That condemnation is supported by their superior understanding of the legal system. It did not happen overnight. Over years and decades, laws have been generated that enable government to pursue an agenda that would normally be considered unconstitutional by most American standards. In Oregon the Department of Human Services (DHS) primarily pursues court actions through the juvenile court system. The opposing party is put on the defense. An opposing party is considered guilty until proven innocent. In cases like ours the judge is the decider, no jury required. The State has unlimited funds for legal representation and experts. Unless money is of no consequence to those challenging the state, a public defender is the degree of legal help most receive. Money was of a consequence to us though we soon found out, that a public defender is not the best option in today’s court. Time is of no consequence to DHS. Once embroiled in a court case they are exacting their job description. Whereas their opponents have to shift, maneuver and crunch their daily lives at the expense of the system. Understand that court is only held during the work week and during normal working hours.

My experience with the system was brought on by an injustice that occurred in my family. I am the grandfather of an infant that was stricken with rickets. His parents are the typical loving mother and father. They have been accused by the State of Oregon of abusing their five week old son.

Here is our story:

On October 1, 2011 - my grandson was born. He was like his mother, stubborn as he refused to come out when the time was near. It had been two weeks since his scheduled delivery time. The doctor wanted to induce labor. My daughter was upset and concerned as she had read a lot about the medicine they were going to use. It was Pitocin, a highly controversial induction medication. I assured my daughter that the doctor knew what was best. The delivery was rough to say the least. My grandson got stuck coming out. My grandson was what is known as “Shoulder Dystocia”. His shoulders were stuck in the pelvis. The doctor manipulated my grandson with his hands for about 90 seconds which was a long time, in a scary situation. The infant was blue and not breathing when he finally inched through. The delivery team corrected his breathing and aside from being bruised, my grandson looked fine. His ABGAR score at birth was 3 (out of ten). That is a scale hospitals use to assess a child’s health at birth. He was not X-rayed at the time as X-rays are not normally done on newborns for obvious reasons. Unfortunately another infant was admitted to the hospital that was dead or dying on arrival. We totally understand the hospitals priority in that matter. Though, his misfortune took up practically the entire hospitals attention, which included the pediatrician on duty. Although close monitoring of my grandson by the pediatrician had been requested by the delivery doctor, it did not occur.

To top off my grandsons condition he had jaundice. Not severely but it took a few days to clear up. (In the past year I have researched many publications and presentations, one of particular interest for our case was a Dr. Sabah Serveas. She presented a power point lecture at a radiologist conference about birth injuries that resemble abuse. A Dr. Kleinman did an article addressing the problems with diagnosing metaphyseal fractures which mentions rickets.)

After leaving Willamette Valley Medical Center (WVMC) my grandson had to return the following 2 days for check-ups on his jaundice condition. The parents were exceptional in looking after his health needs. He had 2 well baby checks in his first two weeks. At about the third week he was seen by a doctor that performed a circumcision. On Nov. 7th he was seen along with my daughters mid wife. The mid wife admired my grandson during their visit. And of course the doting grandparents were almost always hovering close by. Everything was just perfect.

Clearly nothing was out of place. If there was any sign of neglect or abuse it is only logical that it would have been reported.

The nightmare that ensued has challenged my belief and respect for the system. It all started on Nov. 8th 2011. My grandson was 5 weeks old at this time. He had from birth been fussy and requiring a lot of love and attention. He was fussier than normal, and on Nov. 7th, his temperature was slightly elevated and he had been expelling a higher than normal amount of gas. My daughter administered baby Tylenol for his fever and an over the counter gas relief (gripe water). The next day his temperature was still slightly elevated (100.1). Whenever he was adjusted for feeding or diaper changes it was obvious he was in discomfort. The parents called an advice nurse that instructed them to have a doctor take a look at the infant, just to be on the safe side. It was after 5pm and the only available medical attention was the emergency room at WVMC.

When they arrived they saw a receptionist that took care of the initial paper work and had them wait for their examination. That wait was about an hour long. Important, as it must not have appeared that the infant required any emergency care. Once in the exam room, a triage nurse evaluated my grandson’s condition. Of importance is that she is quoted in her report stating, “All four extremities are strong and moving equally”. She does not pass down any concerns about the infant’s leg or suggest special care to the on duty pediatrician. Next, the duty pediatrician (Dr. Shaver) examined my grandson, noting in his report that upon entering the room he sees the infant laying on the table calmly looking about. After doing a visual check the doctor performs a hip check. My daughter and son-in-law heard and see my grandson scream. This is the first time either of them has heard him scream in his short few weeks. The doctor performed another hip check and another scream occurred. The doctor said that it was normal for an infant with abdominal issues. The doctor requested an abdominal X-ray and left the room. At 2006 hrs an X-ray tech entered in the room with a portable X-ray and attempted to do an X-ray of the abdomen.

As described to me: While positioning the child, the tech asks my son-in-law if the doctor had said anything about the child’s leg. The doctor had not. The tech X-rays the abdomen and leaves with his portable X-ray. Thirty minutes later at 2036, the tech returns with his portable X-ray and performs an X-ray of the child’s leg. This x-ray shows that the left femur is fractured. (During court, the doctor stated that he had ordered the X-rays at the same time.) The doctor advises that because the parents cannot explain how this happened, he is doing his job and starts a mandatory investigation. The parents are sincerely concerned for their child and hope the investigation explains what is wrong with their child.

Of note and surely to battle in the court room later is why did the doctor not convey his concerns about the leg from the beginning? In the judge's opinion it was stated that the doctor was immediately aware of a problem with the leg. Seriously? He ordered an abdominal X-ray. He does not pass on any information to the X-ray tech about careful handling of the leg? Had my grandson been discharged that night with concern only for his stomach what would have been the hospitals response when later he was brought in for a broken leg? Prior medical attention would have been considered thorough and no sign of injury.

Jim Dossett's Grandchildren

Anyway, my grandson is transferred to Oregon Health and Science University (OHSU)/Doernbechers hospital. There, a battery of tests is done. At this time there is slight swelling on the left leg that had not been there before. There was a skeletal survey done and it showed the femur fracture, some metaphyseal fractures and three rib fractures healing in various stages. There was no bruising, no soft tissue damage, no retinal hemorrhaging, no neck or head injuries, and no internal organ damage (internal CT scan was completed also with only minor differences in bone condition). The Abuse team nurse requests a vitamin D level blood test. Complete blood panels are done. Calcium, Phosphorus and PTH levels are also requested. Vitamin D, Phosphorus and calcium and PTH levels are essential to establishing bone strength without doing a bone density check (which was not done). The Vitamin D test was lost? The Calcium and Phosphorus were classified as Quantity Not Sufficient. And the PTH was Not Received.

Later - this is extremely important, everyone totally ignored this major discrepancy in our case.
On Nov 9th at an emergency hearing in Yamhill county court we had our first taste of how the DHS exults its power. After hearing all of the evidence the judge (Easterday) ordered that my grandson and his sister be allowed to stay with the parents until the jurisdictional hearing in January, under the stipulation that I and my wife be safety supervisors. That was generally accepted, as the parents and children were living with us at the time. At that point the DHS case worker Becky Brewster raised her hand and told the judge that she must reconsider. She told the judge that she needs to know that the infant boy had multiple fractures and liver damage. The word fracture was used for effect by DHS. Metaphyseals are located on the ends of the bones. Whenever someone hears fracture the visual of a bone snapped in half comes to mind. That is not the case with metaphyseal. The article by Dr Kleinman states that metaphyseal are indistinguishable from Rickets. And the presentation by Dr Servaes describes them as common in birth.

Becky Brewster in my opinion is an overzealous attention seeking case worker that feels that she is empowered with the duty of saving the children no matter what the cost. Unfortunately that weighs in with ignoring parenting rights, the constitution and lying under oath to accomplish her mission.

For the record - My 18 month old granddaughter was subjected to a skeletal X-ray upon the judge’s request. Her health was perfect.

The petition that was presented to the court listed the femur fracture as a fracture, the metaphyseal and rib fractures were at the time listed as possible and probable. The liver was not listed as damaged. The petition stated that liver enzymes were elevated, indicative of liver damage. The enzymes were elevated. At the time of the emergency hearing we explained that the doctor that performed the tests had confirmed to us that there was no liver or any internal damage. We fought that misrepresentation for most of our battle with the state. The judge (Cal Tichenor) wrote in his opinion that liver damage was ruled out and was not a consideration in his findings. One thing that annoys me is that we told everyone that my grandson had a low fever and that he had been given children’s Tylenol. Our research found that Tylenol raises the very liver enzymes that were being used to accuse us of abuse. Really, none of the doctors gave it a thought.

As is protocol for skeletal X-rays a follow up is required approximately 2 weeks later for evaluation of the healing process. On December 2, a second Skeletal X-ray was performed. On this one the same radiologist that read the first one mentioned that there was minimal periosteal formation on the 5th rib. Periosteal is what forms around bones in the healing process. The original X-ray showed no signs of a fracture on the 5th rib, nor did the CT scan (The radiologist had ordered the CT because she stated that it has a better modality for viewing ribs). The first Skeletal X-ray and CT scan on Nov 9th were basically identical though the CT scan reader had actually identified a rib (#7 rib) that the radiologist for the skeletal X-ray had identified as a fracture, stating that it was actually just artifact(?). The infant was out of the parent’s custody as of the 10th of Nov.When the Skeletal X-ray was done on Dec 2nd any fracture phase not on the first set was something that had to have occurred while in the states custody.The logical explanation is that a bone was fractured while the infant was in the states care. The radiologist did try to maneuver around how it could have happened. She was unable to deny that it was possible and could have occurred while my grandson was in foster care (state custody). Judge Tichenor ordered a 3rd X-ray during our first hearing to settle that argument. DHS ignored that order. Also, of note is that one of the liver enzymes presented as being elevated and indicative of a fracture (ALT) was at its highest level when checked while in the states care.

Our case was never one with criminal charges. It has always been a fight with DHS over custody. They had taken an infant away from a family without any factual evidence. There was no evidence of a crime having been committed. Yes, a non mobile child had a broken leg. There are, as I have found numerous medical explanations for weakened bones in infants. Diseases and vitamin deficiencies account for many. An infants' bones are “normally” strong and or pliable and do not break easily.

If as the experts had detailed in our case, there should have been attendant signs of abuse if in fact abuse had occurred. In our case where there was no explanation for what happened to my grandson’s femur. There was no swelling, no bruising, no soft tissue damage, no internal organ damage, no head or neck injuries.

When a child is taken from a family by the state, the court system gets involved and that is where this case turned horrific. On Nov.10, 2011 DHS took control of my grandson. Then the court system had to set up a hearing to hear testimony and the evidence. That was not possible until Jan.5th - almost 2 months later. Imagine having your child taken away knowing that he must have some kind of a condition that caused all of this and the system just whisks him away for months until you prove it was a health condition. It is insane. The parents have no drug, alcohol or domestic issues. Both are educated with a degree or seeking a degree. They have a perfectly healthy 18 month old (at that time). The infant that was taken had a rough delivery. All of this background info readily available and they take the infant away. The State knows that once they take custody, they are aware of the immense burden that places on them. They now have to justify it. The State has a huge legal team at their disposal. We know something is wrong with the infant’s bones. We make an appointment with the Shriner’s Hospital to have him checked out. Upon DHS finding out about this Becky Brewster cancels the appointment. When on the stand and asked if she had in fact cancelled it, she denied it. The judge presented her with the Shriner’s Document that showed her name as the person that had in fact cancelled the appointment! This action was ignored by the court; accept to make DHS arrange for another Shriner’s appointment. All DHS allowed Shriners to do in that rescheduled appointment was to review current medical records. No new testing was done.

Judge Tichenor heard our case in January and disregarded all of our experts, including one Dr David Ayoub, a radiologist with 23 years experience. That expert diagnosed my grandson with neonatal rickets and was 100% sure of his diagnosis. Two other doctors, one a pediatrician with 16 years experience and a medical emergency doctor with 30 years experience. Both felt that abuse was not the cause of the injuries. Pointing out that they had never seen a traumatic leg fracture without attendant outside signs of injury. Even the infant’s pediatrician who had been seeing the infant while in the states care wanted further testing done. He was not convinced it was abuse.

In my opinion the judge ruled in such a way as to take the responsibility away from the court. This also allowed him to let his DA win the case. If the judge ruled in favor of the state, it would go as most cases go. The State will control what the parents have to do to get their infant back. Psychological testing, parenting classes, visitation control, etc. All under the guise that it is in the best interest of the infant. It is a win win for the judge. All he has to do is write his opinion so as to justify his ruling. Now, what if the ruling affects the rest of the life of the parents and the child’s future? In our case with the parents, one has a psychology degree and the other is working towards one in that field. Where will they be able to use those degrees? They will be placed on a child abuser list for the rest of their lives. Would you think that it would be in the best interest of your child to give up your future source of income and their stability? Throw away all that money invested in a private college (Linfield College).

Currently we are still fighting. We lost our case in the first hearing. Albeit we believe that the transcripts bear out that the judge’s decision was wrong. He admitted that he did not know what happened to the infant. Plus how can he rule on a preponderance of the evidence when there was still doubt as to the occurrence of the 5th rib being fractured? The appeals Court chose the same course of action as Judge Tichenor. They did not read the transcripts as we requested.

New evidence has surfaced since the first hearing. Of course it could not be presented to the appeals court because it was not part of the first hearing. We are requesting a new hearing to review that an endocrinologist report done after the hearing showed that my grandson had been started on a high dosage prescription - Ergocalciferol D2 oral Nov 25th . During the original hearing the States expert, Dr. Valvano had convinced the judge that vitamin D was not important. We had argued during the hearing that Vitamin D fortified formula was used extensively prior to the blood test and that alone would have significantly increased his vitamin D level. My grandson’s levels were deficient at 20.7 even after formula supplementation.(Formula contains at least 40 IU of vitamin D per serving size)We are aware of 5 straight days of only having formula prior to the blood test which equates to about 400 UI a day of Vit D. We are adamant that the supplementation not only raised his levels, but was used along with the Ergocalciferol D2 to treat a bone condition.Which ironically is the vitamin that Dr Valvano said was not important.

At one point during this ordeal we suspected sex abuse and physical abuse of my grandson. The judicial system proved its unworthiness to me again. Once we submitted for a hearing to get my grandson out of that situation. The court in its almightiness scheduled a hearing for 2 weeks away. Yes, two weeks. All the while the infant was to stay in a home that had had suspected child abuse. When we finally made it to court the state argued for almost an entire day. The hearing was originally scheduled for an hour and changed on the day of the hearing for 3 hours. After all was said and the day was completed. The hearing was not. It was again scheduled to be seen again in 2 months. YES, two months later, all the while my infant grandson remained in the same foster care. It is ludicrous! Nothing in the world boils me over as much as the double sidedness of the court. When child abuse is suspected by DHS the state will take your child away in an instant. But when the shoe is on the other foot, the lines are crossed and the rules changed. No one has been able to explain to me how the best interest of the child is served when the State is only concerned with its own best interests!

We have been fighting this case now for over a year. We know that we are right and that the only reason this has gone on for so long is because of the states power. They control the courtroom in this particular kind of a case. They are normally dealing with parents that are either guilty or can only afford a public defender that probably councils them to do whatever the state says and just walk away. We have had three public defenders and have hired 3 different attorneys. One has stood by our side the entire time. His experience in this type of a case spans 35 years. He is determined to win. We also hired an attorney to represent us in a petition for review, sent to the Oregon Supreme Court. We found out this past February that the Oregon Supreme Court will not take on our case. We will not stop fighting.

My daughter and Son-in-law did not abuse their son. That is the truth and the truth stands alone, it will always be the truth.

Jim Dossett
ABH1 (E-6)
USN Retired

American Heart Month

14 February 2013

Did you know February is American Heart Month sponsored by the American Heart Association? Heart month is a time to educate people on what we can do to prevent heart problems and live heart-healthy lives.

Heart disease is a major problem for both men and women in the United States. Every year, about 715,000 Americans suffer a heart attack. About 1 out of every 4 deaths is a result of heart disease, the leading cause of death for men and women in the US.

The good news? Heart disease is preventable. Improving your overall health will greatly reduce your risk of heart disease. Did you know having sufficient vitamin D levels may help?

Research has shown that vitamin D deficiency can actually increase your risk of heart disease. A recent Norwegian study found that people with the lowest vitamin D levels had a 32% greater risk of mortality from cardiovascular disease than those with the highest vitamin D levels.

Some lifestyle habits can put you at an increased risk for developing heart disease. Here are some useful tips to help you improve your heath and manage any existing medical conditions you may have.

• Eat a healthy diet- Eating a diet full rich with fruits and vegetables can help you avoid heart disease and many complications associated with the disease. Also, eat foots low in saturated fat, trans fat, cholesterol, and sodium.
• Maintain a healthy weight- Being overweight or obese can increase your risk for heart disease. If you know your height and weight, you can calculate your body mass index (BMI) here.
• Exercise regularly- Regular physical activity can help you achieve or maintain a healthy weight.
• Don’t smoke- Smoking cigarettes greatly increases your risk for heart disease. We’ve all heart it a million times, but if you don’t smoke, don’t start, and if you do, quit ASAP!
• Limit alcohol use- Avoid drinking too much alcohol, as it can increase your blood pressure.
• Have your cholesterol checked- Your doctor should test yourcholesterol levels at least once every 5 years.
• Manage your diabetes- If you have diabetes, monitor your blood sugar closely.
• And of course, make sure your vitamin D levels are sufficient! The Vitamin D Council recommends healthy adults supplement with 5,000 IU/day vitamin D3.

Take a look at our Heart Health infographic for some quick info on vitamin D and heart health. Remember to share with friends and family! View the infographic on Facebook to share online.

Sources

CDC Features. February is American Heart Month. Centers for Disease Control and Prevention. February 4, 2013.

February National Health Observances. Office of Disease Prevention and Health Promotion. February 2013. [PDF]

Page last edited: 14 February 2013

Vitamin D news - New suggested label messages for vitamin D supplements in the UK

12 February 2013

The Department of Health in the United Kingdom has issued new recommendations for label messages for vitamin D supplements.
The new suggested labeling targets specific populations, some at higher risk of vitamin D deficiency than others.
For instance, the Department of Health suggested wording specifically targeted for people who do not get much sun exposure. “The Chief Medical Officer recommends that people who are not exposed to much sun, [for example those who cover their skin, who are housebound or confined indoors for long periods] should take a daily supplement of 10μg of vitamin D.” 10μg is equivalent to 400 IU of vitamin D.
The Department of Health also made suggested labeling messages for children 6 months to 5 years old, pregnant and lactating mothers, and to people over the age of 65. The wording for these targeted groups can be found on their website: http://www.dh.gov.uk/health/2013/02/vitamin-d-supplements/
Source
Department of Health. Department recommends product label messages on vitamin D supplements for at risk groups. February, 2013

Low vitamin D linked to sepsis, mortality

http://www.vitamindcouncil.org/low-vitamin-d-linked-to-sepsis-mortality/

25 January 2013

Research reported at the Society of Critical Care Medicine meeting found that people who are vitamin D deficient have an increased risk of developing sepsis – a severe blood infection – and an increased risk of death if they develop sepsis.

Kenneth Christopher, MD, of Brigham and Women’s Hospital in Boston reported that people who had low vitamin D levels prior to being admitted to the hospital were significantly more likely to develop sepsis after hospitalization compared to patients with normal vitamin D levels. Among patients who developed sepsis, the odds of dying within 30 days was greater for people with deficient or insufficient vitamin D blood levels.

Dr Christopher and colleagues analyzed data from 3,400 adult patients who received care in the ICU at two Boston hospitals from 1998 to 2011 who had vitamin D blood test up to a year prior to hospitalization. Within 12 months, 26% of patients died. The authors found that the mortality rate was higher for those with sepsis, reaching 44.6%. Vitamin D deficiency pre-admission was significantly associated with sepsis, an association which remained after correcting for confounders.

Another study presented by Bryan Nguyen, MD, of Loma Linda University in California offered support to the Boston research.

Dr Nguyen and colleagues uncovered a related link between vitamin D status and an increased mortality risk in patients with sepsis. They analyzed the link between vitamin D levels in the first 72 hours of hospitalization and 30-day mortality in patients with sepsis. The study included 91 emergency room patients who were admitted to the ICU. Eleven percent of the patients died within 30 days.

The patients who died had significantly lower vitamin D levels at admission, compared to those who survived the first 30 days (p=0.04). Interestingly, parathyroid hormone levels were significantly higher among patients who died within the first 3 days in the ICU.

The researchers are cautious to celebrate vitamin D as a cure-all for sepsis, but they support its potential ability to expedite recovery time.

Nguyen concludes that the study “does suggest that 1,25(OH)₂D may be a viable therapeutic target in the design of future sepsis clinical trials while we're trying to tease out the various mechanisms of vitamin D deficiency in these patients."

Source

Neale T. Low vitamin D tied to poor sepsis outcomes. Medpage Today. Jan 23, 2013.

Page last edited: 25 January 2013

Dr Michael Holick: What does the sun do for me?

January 22, 2013

Are you ready for the second Grassroots Health webinar?




Today at 10am PST Dr Michael Holick will be discussing the question: "What does the sun do for me?"




Register here for today's webinar! Have a vitamin D question? You can submit your questions for Dr Holick when you register.

Treatment of D deficiency: Oral supplement or vitamin D3 injection?

http://www.vitamindcouncil.org/treatment-of-d-deficiency-oral-supplement-or-vitamin-d3-injection/

6 January 2013

Researchers recently conducted arandomized controlled trialassessing the effectiveness and practicality of oral vitamin D supplements compared to intramuscular vitamin D supplement injections in the treatment of vitamin D deficiency.

Researchers in Iran randomized 92 patients with vitamin D deficiency (< 30 ng/ml) to receive 300,000 IU vitamin D3, either intramuscularly as a single injection or orally in six divided doses over a 3 month period (about the equivalent to 3,300 IU/day). Vitamin D blood levels were measured at baseline, three, and six months.

The researchers found that both treatment regimens significantly increased vitamin D blood levels. Vitamin D status at 3 months was significantly higher in oral than in the injection group, with levels at 36 and 23.5 ng/ml respectively (p=0.03). At 6 months, levels were similar (20.8 and 24.8 ng/ml respectively).

The researchers conclude that both regimens are safe, effective, and practical, “Although we revealed superiority of oral route, at least at early short time, the way of treatment may depend on the patient's choice, compliance and availability of various forms of the drug in any regions.”

Source

Zabihiyeganeh M, Jahed A, Nojomi M. Treatment of hypovitaminosis D with pharmacologic doses of cholecalciferol, oral vs intramuscular; an open labeled RCT. Clinical Endocrinology. January 2013.

Page last edited: 16 January 2013

Vitamin D: Most popular vitamin of 2012

http://blog.vitamindcouncil.org/2013/01/19/vitamin-d-most-popular-vitamin-of-2012/

Posted on January 19, 2013 by Dr William Grant

There were 3600 publications with vitamin D in the title or abstract in 2012 according to PubMed.gov. This brings the total number of publications on vitamin D listed at PubMed to 33,800 (http://www.ncbi.nlm.nih.gov/pubmed). This total compares to 35,100 on vitamin C or ascorbic acid, 21,700 on vitamin E, 19,100 on vitamin A, 17,600 on folate, and 12,000 on vitamin B12. However, since the beginning of 2000, there have been 20,500 publications on vitamin D but only 16,300 publications on vitamin C or ascorbic acid. Thus, vitamin D is the most popular vitamin even though strictly speaking it is not a vitamin. Instead, it is a necessary hormone that can be made in the body through the action of ultraviolet-B (UVB) light. However, it can also be obtained orally through the diet or supplements.

Top 16 Vitamin D Papers of 2012

The following list of top vitamin D papers for 2012 was selected from a search at PubMed.gov at the end of 2012. The list started out with 60 of candidate papers. This list was then sent to a panel of vitamin D researchers and advocates, who added a few more papers, then voted on the entire list. The final list has papers from a variety of health effects. Many other fine papers could not be included due to space limitations.

4,000 IU vitamin D3 was of great help during pregnancy

A topic that generated considerable interest this year was the role of vitamin D during pregnancy. In a pair of papers, researchers from the Medical University of South Carolina discussed the findings and implications of their randomized controlled trial of vitamin D supplementation during pregnancy.^{1, 2} Over 300 women were enrolled in the study. Women were assigned to take supplements containing 400, 2000, or 4000 IU/d vitamin D3 or a placebo. No adverse effects were found such as hypercalcemia or hypercalcuria. This study found that it took 4000 IU/d to raise serum 25-hydroxyvitamin D [25(OH)D] levels to about 40 ng/ml (To convert to nmol/l, multiple ng/ml by 2.5.), a nearly optimal level of 1,25-dihydroxyvitamin D. 1,25-dihydroxyvitamin D is the active or hormonal metabolite of vitamin D which among other things controls the expression of several hundred genes. (See Hossein-nezhad and Holick [2012] for a summary of the effects of vitamin D on fetal development.³) In the study, those taking the higher vitamin D doses had significantly reduced risk of primary Cesarean section delivery and pre-eclampsia. Other adverse pregnancy outcomes occur with vitamin D deficiency such as premature delivery and low birth weight, but too few women were enrolled in this study to find statistically significant results on these conditions.

Mounting evidence that vitamin D deficiency is an important risk factor for autism

A study from Saudi Arabia examined the relation between serum 25(OH)D level and anti-myelin-associated glycoprotein (anti-MAG) auto-antibodies in autistic children near the age of eight years.⁴ There was a very strong inverse relation between the two levels (r = -0.86).

Low vitamin D during pregnancy is associated with childhood language impairment

A study in Perth, Australia measured serum 25(OH)D levels at 18 weeks into pregnancy, and then measured language impairment of the offspring at 5 and 10 years of age. It found that women with serum 25(OH)D levels below 18 ng/ml had children with twice the risk of clinically significant language difficulties compared to those with 25(OH)D levels above 28 ng/ml.⁵ Exactly why is not currently known, but there are many possibilities. It is noted that in the United States in the early 2000s, white women of childbearing age had mean 25(OH)D level of 26 ng/ml while black women of childbearing age had mean 25(OH)D level of 14 ng/ml. Both of these levels are low by current standards. As explained below, skin color is directly relevant to serum vitamin D levels produced by exposure to sunlight.

Higher vitamin D is associated with lower all-cause mortality rates

A topic of interest at the other end of life was the relation of mortality rate to serum 25(OH)D levels. A meta-analysis of 11 observational studies and 60,000 individuals found a reduction in risk over about 10 years for highest vs. lowest category of 25(OH)D level of mortality of 29%.⁶Comparing graded levels of intake, the reduction in risk was 14% for an increase of 5 ng/ml, 23% for an increase of 10 ng/ml, and 39% for an increase of 20 ng/ml in plasma levels of 25(OH)D, starting from a median of ~11 ng/ml. The participants starting with the lowest levels of serum 25(OH)D received the greatest benefits. Those who started with higher serum levels, closer to optimal (30-40 ng/ml), received less benefit from additional vitamin D. This relation between starting serum 25(OH)D levels and health outcome is not surprising because it is similar to many other health studies. Since 25(OH)D levels likely changed over the duration of the studies, and some participants died of unrelated causes, the actual effect of serum 25(OH)D level on mortality rate is greater than these estimates.

And less cardiovascular disease

Cardiovascular disease is an important contributor to mortality rates. A study of 11,000 patients in Kansas was reported. The patients had a mean age of 58±15 years, a body mass index of 30±8 kg/m², and a mean serum 25(OH)D level of 24±14 ng/ml.⁷ Serum 25(OH)D levels below 30 ng/ml was significantly associated with several cardiovascular-related diseases, including hypertension, coronary artery disease, cardiomyopathy, and diabetes. After a period of 5.5 years, those with serum 25(OH)D levels below 30 ng/ml had twice the mortality rate of those with higher 25(OH)D levels.

And less risk of diabetes mellitus type 2

In a 2.7-year study of 2000 prediabetics, participants with the highest third of 25(OH)D levels (median, 30.1 ng/ml) had a reduction in risk of 28% for developing diabetes mellitus type 2 compared with participants in the lowest third (median, 12.8 ng/ml).⁸

. . . and less diabetes mellitus type 1 (T1DM)

An observational study on insulin-dependent diabetes mellitus (T1DM) was based on 1000 U.S. military service personnel who developed this disease between 2002 and 2011.⁹ They had provided blood samples between one and ten years prior to developing T1DM. They were carefully matched with another thousand service personnel who did not develop T1DM. There was a reduction in risk of 78% for developing T1DM for those with serum 25(OH)D levels above 24 ng/ml compared to those with levels below 24 ng/ml. This finding is highly statistically significant and is one of the strongest studies of its type.

Fewer bacterial and viral infections

The effect of vitamin D in reducing risk of infections is a topic of increasing interest. Vitamin D reduces risk of infections primarily by strengthening the innate immune system, primarily by inducing production of cathelicidin, a polypeptide with antimicrobial and antiendotoxin properties. It also shifts production of cytokines, a type of cell signaling molecule, away from proinflammatory ones, and has a number of other actions on both the innate and adaptive immune system.¹⁰ While the effects of vitamin D have been found mostly for bacterial infections, some have also been reported for viral infections such as influenza, HIV, and hepatitis C.¹⁰ In a supplementation study in Sweden involving 140 patients with frequent respiratory tract infections (RTIs) using 4000 IU/d vitamin D3, those in the supplementation group increased their serum 25(OH)D level to 53 ng/ml while those in the placebo group had levels near 27 ng/ml.¹¹ Those taking vitamin D3 had a 23% reduction in RTIs and a 50% reduction in the number of days using antibiotics.

The benefits of vitamin D in reducing risk of cancer

One of the important and well-documented effects of vitamin D is reduced risk of cancer and increased survival after cancer diagnosis. There were 400 publications on vitamin D and cancer in 2012 according to PubMed.gov. Evidence from ecological, observational and laboratory studies have identified over 15 types of cancer for which higher solar UVB light and/or serum 25(OH)D levels are associated with reduced risk. Two of the papers are especially noteworthy. One, a study from Norway involving 658 patients with either breast, colon, lung, or lymphoma with serum 25(OH)D levels determined within 90 days of cancer diagnosis were followed for up to nine years.¹² Compared to those with levels 32 ng/ml had a reduction in risk for dying from cancer of 66%. To a cancer patient, this would be a lifeline.

Another cancer paper reported the results of supplementation with 4000 IU/d vitamin D3 of those with low-grade biopsy-assayed prostate cancer.¹³ Forty four patients successfully completed the one-year study. Twenty four of the subjects (55%) showed a decrease in the amount of cancer; five subjects (11%) showed no change; 15 subjects (34%) showed an increase. In comparison, with a historical group of 19 patients, only 4 (21%) had reductions in the amount of cancer, 3 (16%) showed no changes, and 12 (63%) showed an increase in cancer. Thus optimal vitamin D supplementation appears to be useful for treating those with cancer.

Falls and fractures

The classical role of vitamin D is to regulate calcium and phosphate absorption and metabolism, leading to strong bones. A pooled analysis of 31,000 persons (mean age, 76 years; 91% women) participating in randomized controlled trials of vitamin D supplementation who developed ~1000 incident hip fractures and ~3800 nonvertebral fractures found that those with the highest intake (median 800 IU/d; range 792-2000) had a 30% reduction in risk of hip fracture and a 14% reduced risk of nonvertebral fracture.¹⁴ The role of vitamin D in neuromuscular control also plays an important role in reducing risk of falls and fractures.

Skin pigment adapts slowly to changed ultraviolet environment

Jablonski and Chaplin have published a series of papers on human skin pigmentation and its relation to solar ultraviolet radiation (UVR).¹⁵ Their primary thesis is that human skin pigmentation has adapted to UVR conditions where a group of people live for 50 generations, or about a thousand years. UVR from mid-day sunlight produces vitamin D, which provides important protection against many diseases, but sunlight also causes skin cancer and destruction of folate. Dark skin protects against free radical production, damage to DNA, cancer, and loss of folate. Thus, dark skin is best in the tropical planes regions while pale skin is best at high latitude regions. Those with skin adapted to UVB between 23° and 46° have the ability to tan, which is an adaptation to seasonal changes in solar UVB doses. However, in recent times, people have moved or traveled to regions where their skin pigmentation is not suited to the local UVR conditions. They discuss three examples: nutritional rickets, multiple sclerosis and melanoma. Their abstract concludes with this observation: “Low UVB levels and vitamin D deficiencies produced by changes in location and lifestyle pose some of the most serious disease risks of the twenty-first century.”

Vitamin D levels for traditionally living Africans

A study on traditionally living Africans near the equator provides information on “normal” 25(OH)D levels. A paper was published on serum 25(OH)D levels of the Masai and the Hadzabe living near 4° S in Tanzania.¹⁶ They have skin type VI (very dark), wear a moderate amount of clothing, spend the major part of the day outdoors, but avoid direct exposure to sunlight when possible. The mean serum 25(OH)D levels of Maasai and Hadzabe were 48 (range 23-67) ng/ml and 44 (range 28-68) ng/ml, respectively. This finding suggests that serum 25(OH)D levels in the range of 40-50 ng/ml may be optimal for human health, which is generally consistent with observational studies for a number of health outcomes.

Vitamin D is made by exposure to sunlight to a significant degree only when the sun is 45 degrees or more above the horizon. At the latitudes of North America and Europe, this is summer midday sunlight between the hours of 11 a.m. and 3 p.m. In the early morning or late afternoon, light-skinned individuals may tan but they hardly get any vitamin D from sunlight. And in the winter, nobody gets much vitamin D from the sun. This explains the health benefits of taking supplements of vitamin D.

Summary and Conclusion

Thus, the evidence that serum 25(OH)D levels above 30-40 ng/ml are required for optimal health continues to mount. It takes 1000-4000 IU/d vitamin D3 to reach these levels in the absence of significant UVB exposure. The evidence comes from a variety of studies including observational and laboratory studies and randomized controlled trials (RCTs). While RCTs are required to demonstrate effectiveness and lack of harm for pharmaceutical drugs which, by definition, are artificial compounds, they should not be required for vitamin D since it is a natural compound important for all animal life including humans. In addition, RCTs on vitamin D are difficult to conduct due to other sources of vitamin D and reduced conversion of vitamin D to 25(OH)D level at higher serum levels. It will take five years or more before large-scale RCTs testing vitamin D supplements are completed and reported. The adverse effects of oral intake of up to 4000 IU/d vitamin D3 and serum 25(OH)D levels up to 100 ng/ml are practically non-existent except for those individuals with conditions that may lead to hypercalcemia. Thus, there seems to be little reason to wait for the RCTs before implementing vitamin D policies of higher oral intake and/or moderate UVB exposure and serum 25(OH)D levels. Everyone in North America and Europe should take a supplement of 1000-4000 IU/d of vitamin D in the winter, and those with dark skin or office jobs should take vitamin D all year long. Supplementation with vitamin D is an inexpensive and very effective way to produce huge health benefits.

For further information on vitamin D, the interested reader is directed to these websites:http://www.Grassrootshealth.net, http://www.VitaminDCouncil.org, andhttp://www.VitaminDWiki.com. Dr. Grant is director of http://www.sunarc.org.

References:

1. Hollis BW, Wagner CL. Vitamin D and pregnancy: Skeletal effects, nonskeletal effects, and birth outcomes. Calcif Tissue Int. 2012 May 24. [Epub ahead of print]
2. Wagner CL, Taylor SN, Dawodu A, Johnson DD, Hollis BW. Vitamin D and its role during pregnancy in attaining optimal health of mother and fetus. Nutrients. 2012;4(3):208-30.
3. Hossein-nezhad A, Holick MF. Optimize dietary intake of vitamin D: an epigenetic perspective. Curr Opin Clin Nutr Metab Care. 2012;15(6):567-79.
4. Mostafa GA, Al-Ayadhi LY. Reduced serum concentrations of 25-hydroxy vitamin D in children with autism: relation to autoimmunity. J Neuroinflammation. 2012;9:201.
5. Whitehouse AJ, Holt BJ, Serralha M, Holt PG, Kusel MM, Hart PH. Maternal serum vitamin D levels during pregnancy and offspring neurocognitive development. Pediatrics. 2012;129(3):485-93.
6. Zittermann A, Iodice S, Pilz S, Grant WB, Bagnardi V, Gandini S. Vitamin D deficiency and mortality risk in the general population: A meta-analysis of prospective cohort studies. Am J Clin Nutr. 2012;95(1):91-100.
7. Vacek JL, Vanga SR, Good M, Lai SM, Lakkireddy D, Howard PA. Vitamin D deficiency and supplementation and relation to cardiovascular health. Am J Cardiol. 2012;109(3):359-63.
8. Pittas AG, Nelson J, Mitri J, Hillmann W, Garganta C, Nathan DM, Hu FB, Dawson-Hughes B; Diabetes Prevention Program Research Group. Plasma 25-hydroxyvitamin D and progression to diabetes in patients at risk for diabetes: an ancillary analysis in the Diabetes Prevention Program. Diabetes Care. 2012;35(3):565-73.
9. Gorham ED, Garland CF, Burgi AA, Mohr SB, Zeng K, Hofflich H, Kim JJ, Ricordi C. Lower prediagnostic serum 25-hydroxyvitamin D concentration is associated with higher risk of insulin-requiring diabetes: a nested case-control study. Diabetologia. 2012 Dec;55(12):3224-7.
10. Lang PO, Samaras N, Samaras D, Aspinall R. How important is vitamin D in preventing infections? Osteoporos Int. 2012 Nov 17. [Epub ahead of print]
11. Bergman P, Norlin AC, Hansen S, Rekha RS, Agerberth B, Bj”rkhem-Bergman L, Ekstr”m L, Lindh JD, Andersson J. Vitamin D3 supplementation in patients with frequent respiratory tract infections: a randomised and double-blind intervention study. BMJ Open. 2012;2(6). pii: e001663.
12. Tretli S, Schwartz GG, Torjesen PA, Robsahm TE. Serum levels of 25-hydroxyvitamin D and survival in Norwegian patients with cancer of breast, colon, lung, and lymphoma: a population-based study. Cancer Causes Control. 2012;23(2):363-70.
13. Marshall DT, Savage SJ, Garrett-Mayer E, Keane TE, Hollis BW, Host RL, Ambrose LH, Kindy MS, Gattoni-Celli S. Vitamin D3 supplementation at 4000 international units per day for one year results in a decrease of positive cores at repeat biopsy in subjects with low-risk prostate cancer under active surveillance. J Clin Endocrinol Metab. 2012;97(7):2315-24.
14. Bischoff-Ferrari HA, Willett WC, Orav EJ, Lips P, Meunier PJ, Lyons RA, Flicker L, Wark J, Jackson RD, Cauley JA, Meyer HE, Pfeifer M, Sanders KM, St„helin HB, Theiler R, Dawson-Hughes B. A pooled analysis of vitamin D dose requirements for fracture prevention. N Engl J Med. 2012;367(1):40-9.
15. Jablonski NG, Chaplin G. Human skin pigmentation, migration and disease susceptibility. Philos Trans R Soc Lond B Biol Sci. 2012;367(1590):785-92.
16. Luxwolda MF, Kuipers RS, Kema IP, Janneke Dijck-Brouwer DA, Muskiet FA. Traditionally living populations in East Africa have a mean serum 25-hydroxyvitamin D concentration of 115 nmol/l. Br J Nutr. 2012;108(9):1557-61.

About Dr William Grant

Dr. William Grant is an epidemiologist and founder of the nonprofit organization Sunlight, Nutrition and Health Research Center (SUNARC). He has written over 140 peer-reviewed articles and editorials on vitamin D and health. Dr. Grant is the Science Director of the Vitamin D Council and also serves on their Board. He holds a Ph.D. in Physics from UC Berkeley.

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